Selected Photomicrographs

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A. Proliferative and secretory phases of the endometrium (Figure 24-2; see IV A)

Figure 24-2. (A) Low magnification of the proliferative phase of the endometrium showing straight endometrial glands. (B) High magnification of the boxed area in A. (C) Low magnification of the secretory phase of the endometrium showing convoluted endometrium glands with secretion product within the lumen. (D) High magnification of the boxed area in C.

Figure 24-2. (A) Low magnification of the proliferative phase of the endometrium showing straight endometrial glands. (B) High magnification of the boxed area in A. (C) Low magnification of the secretory phase of the endometrium showing convoluted endometrium glands with secretion product within the lumen. (D) High magnification of the boxed area in C.

Endocervical canal

Simple columnar epithelium

Prepuberty

Puberty

Adult

B. Cervix-vagina junction, cervical intraepithelial neoplasia, Pap smear (Figure 24-3; see V B 2)

zone

Ectocervix

Vaginal ■ cavity

'Stratified squamous epithelium

C. Squamous cell carcinoma of cervix (Figure 24-4)

Figure 24-4. (A,B) Squamous cell carcinoma of the cervix. Cervical intraepithelial neoplasia, as explained in Figure 24-3, usually precedes the appearance of squamous cell carcinoma. Stratified squamous epithelium (asterisk) in the transformation zone has invaded the underlying stroma, forming nests of malignant cells (arrows). (B) High magnification of the boxed area in A. Squamous cell carcinoma can be treated clinically by radiation and chemotherapy with cisplatin or 5-fluorouracil. (Reprinted with permission from East Carolina University, School of Medicine, Department of Pathology slide collection.)

Figure 24-4. (A,B) Squamous cell carcinoma of the cervix. Cervical intraepithelial neoplasia, as explained in Figure 24-3, usually precedes the appearance of squamous cell carcinoma. Stratified squamous epithelium (asterisk) in the transformation zone has invaded the underlying stroma, forming nests of malignant cells (arrows). (B) High magnification of the boxed area in A. Squamous cell carcinoma can be treated clinically by radiation and chemotherapy with cisplatin or 5-fluorouracil. (Reprinted with permission from East Carolina University, School of Medicine, Department of Pathology slide collection.)

Figure 24-3. (A) Diagram of the cervix-vaginal junction. During prepuberty, the ectocervix is covered by nonkerarinized stratified squamous epithelium that is continuous with vaginal epithelium (black area). At puberty, the simple columnar epithelium extends onto the ectocervix. In the adult, exposure of rhc simple columnar epithelium to the acidic (pH) environment ol the vagina induces a squamous metaplasia, forming the transformation zone (dotted area), which is important clinically. Nabothian cysts (NB) may form in the transformation zone. (B) A biopsy of the cervix showing cervical intraepithelial neoplasia (CJN). In certain areas of the stratified squamous epithelium, the regular stratified pattern is lost such that cells near the surface are oriented vertically (arroutt) instead of horizontally. There is a variation of nuclear size and shape. Mitotic figures near the surface can be observed (double arrows). (C) The cytology of cervical intraepithelial neoplasia as seen on a Pap smear. Normal cervical squamous cells (S) can be observed along with clumps of dysplastic cells (D), which have a large, darkly stained nuclei with a coarse chromatin pattern. (B: Reprinted with permission from East Carolina University, School of Medicine, Department of Pathology slide collection. C: Reprinted with permission from Wheater PR, Burkitt HO, Stevens A, et al: Identification of molecules in the kidney utilizing immunocytochemistry. In Basic Histopathology: A Colour Atlas and Text, 2nd ed. London, Churchill Livingstone, p 176, 1996, by permission of the publisher Churchill Livingstone.)

D. Normal lactating breast, fibroadenoma (Figure 24-5; see VII C)

Figure 24-5. (A) Light micrograph of a normal, lactating breast. Observe the numerous round or oval alveoli surrounded by minimal connective tissue stroma. (B) Light micrograph of a fibroadenoma, which is a benign proliferation of the connective tissue stroma. As a consequence, the glands are compressed into cords of epithelium with slit-like spaces. (C) High magnification of a fibroadenoma showing glandular and stromal elements. A fibroadenoma presents clinically as a sharply circumscribed, spherical nodule that is freely movable. Reprinted with permission from East Carolina University, School of Medicine, Department of Pathology slide collection.

E. Infiltrating duct carcinoma of the breast (Figure 24-6)

Figure 24-6. (A,B,C) Light micrographs of infiltrating duct carcinoma of the breast. The tumor cells are arranged in cell nests (asterisk), cell cords (arrows), anastomosing masses, or a mixture of all of these. The cells are surrounded by fairly thick bands of connective tissue stroma (arrowheads). This is the most common type of breast cancer, accounting for 65%—80% of all breast cancers. Some features that are common to all infiltrative breast carcinomas include: fixed in position, retraction and dimpling of the skin, thickening of the skin (peau d'orange), and retraction of the nipple. The presence of estrogen receptors or progesterone receptors within the carcinoma cells indicates a good prognosis for treatment. Tamoxifen is an estrogen receptor blocker and is a drug of choice for treatment. The presence of the c-erb B2 oncoprotein (similar to the epidermal growth factor receptor) on the surface of the carcinoma cells indicates a poor prognosis for treatment. BRCA-1 (breast cancer susceptibility gene) is an anti-oncogene (tumor suppressor gene) located on chromosome 17(17q21) that encodes for BRCA protein (a zinc finger gene-regulatory protein) containing phosphotyrosine, which will suppress the cell cycle. A mutation of the BRCA-1 gene is present in 5%-10% of women with breast cancer and confers a very high lifetime risk of breast and ovarian cancer.

Figure 24-6. (A,B,C) Light micrographs of infiltrating duct carcinoma of the breast. The tumor cells are arranged in cell nests (asterisk), cell cords (arrows), anastomosing masses, or a mixture of all of these. The cells are surrounded by fairly thick bands of connective tissue stroma (arrowheads). This is the most common type of breast cancer, accounting for 65%—80% of all breast cancers. Some features that are common to all infiltrative breast carcinomas include: fixed in position, retraction and dimpling of the skin, thickening of the skin (peau d'orange), and retraction of the nipple. The presence of estrogen receptors or progesterone receptors within the carcinoma cells indicates a good prognosis for treatment. Tamoxifen is an estrogen receptor blocker and is a drug of choice for treatment. The presence of the c-erb B2 oncoprotein (similar to the epidermal growth factor receptor) on the surface of the carcinoma cells indicates a poor prognosis for treatment. BRCA-1 (breast cancer susceptibility gene) is an anti-oncogene (tumor suppressor gene) located on chromosome 17(17q21) that encodes for BRCA protein (a zinc finger gene-regulatory protein) containing phosphotyrosine, which will suppress the cell cycle. A mutation of the BRCA-1 gene is present in 5%-10% of women with breast cancer and confers a very high lifetime risk of breast and ovarian cancer.

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